Unique presentation of LHON/MELAS overlap syndrome caused by m.13046T>C in MTND5

ABSTRACT

Background: Leber hereditary optic neuropathy (LHON) and mitochondrial encephalopathy, myopathy, lactic acidosis and stroke-like episodes (MELAS) syndromes are mitochondrially inherited disorders characterized by acute visual failure and variable multiorgan system presentation, respectively.

Materials and methods: A 12-year-old girl with otherwise unremarkable medical history presented with abrupt, painless loss of vision. Over the next few months, she developed moderate sensorineural hearing loss, vertigo, migraines, anhedonia and thyroiditis. Ocular examination confirmed bilateral optic nerve atrophy. Metabolic workup documented elevated cerebrospinal fluid lactate. Initial genetic analyses excluded the three most common LHON mutations. Subsequently, Sanger sequencing of the entire mitochondrial DNA (mtDNA) genome was performed.

Results: Whole mtDNA sequencing revealed a pathogenic heteroplasmic mutation m.13046T>C in MTND5 encoding the ND5 subunit of complex I. This particular variant has previously been described in a single case report of MELAS/Leigh syndrome (subacute necrotizing encephalopathy). Based on the constellation of clinical symptoms in our patient, we diagnose the condition as LHON/MELAS overlap syndrome.

Conclusions: We describe a unique presentation of LHON/MELAS overlap syndrome resulting from a m.13046T>C mutation in a 12-year-old girl. In patients with sudden vision loss in which three of the most prevalent LHON mitochondrial mutations have been ruled out, molecular genetic examination should be extended to other mtDNA-encoded subunits of MTND5 complex I. Furthermore, atypical clinical presentations must be considered, even in well-described phenotypes.

KEYWORDS:

• LHON
• loss of vision
• MELAS
• mitochondrial DNA
• ND5
• overlap syndrome

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

This work was supported by grants IGA NT 14156/3, IGA NT 13114/4, GAUK 38515/2015 and by institutional research support by Charles University in Prague (PRVOUK P24/LF1/3, RVO-VFN 64165, SVV UK 260148/2015).

Additional information

Funding

This work was supported by grants IGA NT 14156/3, IGA NT 13114/4, GAUK 38515/2015 and by institutional research support by Charles University in Prague (PRVOUK P24/LF1/3, RVO-VFN 64165, SVV UK 260148/2015).